The effect of drugs used in rheumatology for treating SARS-CoV2 infection

ABSTRACT

Introduction

SARS-CoV-2 is a novel coronavirus that was first isolated from a group of patients hospitalized with pneumonia in China at the end of 2019, and, in February 2020, the syndrome it caused was named coronavirus disease 2019 (COVID-19) by the World Health Organization. In the absence of specific antiviral treatments capable of neutralizing the etiological agent, one therapeutic approach is to control the cytokine storm responsible for the most severe forms of the disease. The characteristic cytokine profile of severely affected patients is increased levels of interleukin (IL)-1β, IL-2, IL-6, IL-7, IL-8, and tumor necrosis factor alpha (TNF-α).

Areas covered

This article discusses the pathogenesis of COVID-19 as a rationale for using the biological and targeted synthetic drugs used in rheumatology (anti-TNF, anti-IL-1 and anti-IL-6 agents and baricitinib) to treat the disease, and provides key information concerning their potential benefits and adverse effects.

Expert opinion

Interleukin inhibition seems to be a promising means of treating COVID-19 patients when respiratory function declines (or even earlier) if there are laboratory data indicating the presence of a cytokine storm because the interleukins are key drivers of inflammation. However, it is important to consider the risks and benefits of biological agents carefully, and critically analyze the evidence concerning their use in COVID-19 patients.

KEYWORDS:

• Pneumonia
• COVID-19
• SARS-CoV-2
• anti-IL6 drugs
• anti-IL-1 drugs

Article highlights

• In the absence of specific antiviral treatments capable of neutralising the SARS-CoV2 infection, one therapeutic approach is to control the cytokine storm responsible for the most severe forms of the disease.

• Despite this pathogenic rationale of anti-TNF, we have found only one study designed to evaluate the effectiveness of adalimumab.

• The use of tocilizumab, a humanised IgG1 monoclonal antibody against the human IL-6 receptor, has already led to promising results.

• The recombinant human IL-1 receptor antagonist anakinra data suggest that it may have a positive effect in patients with severe COVID-19 showing pulmonary involvement with ARDS or the clinical characteristics of MAS.

• Baricitinib, a JAK1 and JAK2 inhibitor used to treat rheumatology patients, which are both involved in the mechanism of viral endocytosis and in the management of a cytokine storm by inhibiting the JAK-STAT pathway has led to some promising results.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.